Provider Demographics
NPI:1669148052
Name:JOHNSON, CHRISTOPHER EVAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:EVAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1305
Mailing Address - Street 2:
Mailing Address - City:SUGARLOAF
Mailing Address - State:CA
Mailing Address - Zip Code:92386-1305
Mailing Address - Country:US
Mailing Address - Phone:909-503-5438
Mailing Address - Fax:
Practice Address - Street 1:1700 KEYSTONE PACIFIC PKWY UNIT C2
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-8874
Practice Address - Country:US
Practice Address - Phone:209-881-9274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist